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y r,5 -OAPPLICATION FOR SAW#C TION PERMIT Permit No.��..... y (Complete in Duplicate) Date Issuecl ' Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. ' This application is made in compliance with County Ordinance No. 549.- JOB ADDRESS AND LOCATION.. - B aa+ la Street Owner's Name ---•---= J,ohIl .T, AraanJmo Phone 4,1,©83 ---- -- ----- ------------_-------------- ------ --.. ----_ Address---------- Same - Same ........................................................ ------ .---- --------- ---- -:. -- ------------------------ . ----------- Contractor's Name.............................D D. A. •_PARRISH & SONS INC,, Phone ..------. ••-•- - - Installation will serve: Residence;99 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel , Other ❑ ` Number of living units. _l-__ Number of bedrooms ---- Number of baths ------ -Lot size -------1P.A)* 4 ` Water Supply: Public system Community system ❑ Private ❑- Depth to Water Table �-_ft Plus Character of soil to a depth of 3 feet: Sand ❑ Gravel❑ Sandy Loam❑ Clay Loam,❑ Clay❑ Adobe[ Hardpan ❑ ❑ [IL New Construction: Yes [l No 0 Drainage supplement Previous Application Made: Yes No TYPE,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest well________________Distance from to undation.........._--...•..Material .... -------------------_ ❑EZigtingNo. of compartments•-- -----_ ----------Size-------- -------------------Liquid depth--- _ ------- ------- Capacity............... Disposal Field: Distance from nearest well Distance from foundation Distance to nearest lot line ❑$xlgtingrNumber of lines- --------- ----------------.Length of each line----------------------------.-Width of trench-----_---c_.................. _---- ' Type of filter material___ ______ ___________Depth of filter material. -----------Total length_-_'.. _.__-. ..--_ See a Pit: Distance to nearest well HQge_____._.Distance from foundation-_19� ..—Dis-tance to'nearest lot ne Number of pits_: X ___ _________Lining material srC Br ClSize. Diameter___ _...........Depth_.__'3 Cesspool: Distance from nearest well-----------.....Distance from foundation---------------_--Lining material-.................... -------------- n : -..._.❑ Size: Diameter--------------------------------------Depth----- -------- ------ --------- --------Liquid `Capacity ---•---- --•-••-------gabs Privy: Distance from nearest well------- .................. Distance from nearest building----- --------- ___._ ❑ Distance to nearest lot Line------- -------- --- ----.......-- -•---=-- ............................................... = Remodeling and/or repairing (describe):.-_--- ---- upplement to .existing- 154' leach drain ------ ---- -------- ------- -------- ------- -------- ------- ------- --__.-- --•--•. --•--•. ----_... .•---• ••---..- I hereby certify that I.have prepared this applicati and that the work will be done in accordance with San Joaquin Counter ordinances, State laws, and rules and regulations of th San Joaquin Local Health District.` (Signed)--- - P 8s' --------- 'Contrector}, - (r+�) Estimator . (Plot p n, s w ng srie--of lot, location of system in r tion t wells, buildings, etc., can be placed on reverse side). F811 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. REVIEWED BY ---- --- -------- -----•- ----- --- - __ . DATE-- BUILDING BUILDINGPERMIT ISSUED----------------- ------------------------------------------- -------- - ,�,, - DATE T� Alterations and/or recommendations- --------- ------- - --- ---- --------------------------- INSPECTION BY:--- -_V_' p ate------------------- FINAL / - ------- ------ -} - SAN JOAQUIN LOCAL HEALTH DrSTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North ..C..Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100